In the mid 1990’s, a group of Kaiser physicians who were working with patients with severe chronic diseases, noticed that they all had stories of terrible childhood events. These physicians developed a 10-question assessment called the Adverse Childhood Experiences (ACE) Scale.
What followed was a large study, tens of thousands of patients, to collaborate their observations. The results stunned even them. People with an ACE score greater than 4 are 230% more likely to have cancer, 200% more likely to have cardiovascular disease, 10 times more likely to abused injected drugs, and 40 times more likely to attempt suicide.
The question facing medicine is what do you do with this knowledge? The adverse events have already occurred. You can’t undo them. How do you change that life’s trajectory? And why do some, subjected to the same trauma, have such different outcomes? Where do they find that resiliency? Can we replicate that?
While most all physicians are aware of the ACE scale, few are aware there is also a PCE scale. 7 Positive Childhood Experiences, that offset the harmful effects of ACEs.
1. Able to talk with my family about my feelings.
2. Felt that my family stood by me during difficult times.
3. Enjoyed participating in community traditions.
4. Felt a sense of belonging while in High School.
5. Felt supported by friends.
6. Had at least two non-parent adults who took a genuine interest in me.
So, my question is this. What social institution offers access to these experiences? Often it is the church community.
Reverend William Glass is an Anglican priest and theologian, fluent in five languages, and possessing an impressive resume in marketing. His story isn’t one of privilege, however. In Glass’s view, the church saved his life.
Glass grew up desperately poor in a Florida trailer park. His religious background was, in his words, “Southern Alcoholic.” His father was either absent or abusive. He had no close friends and school, when he attended, was a torment. Barely into his teens, he began to manage his feelings with drugs and alcohol.
He visited a Presbyterian youth group to impress a girl. His rough life continued, include a time with homelessness, but he found friends in churches who took care of him during crises, help him stay connected, and showed him another way.
Glass said church offered him social and relational capital that was in short supply in his fragmented communities. “The bonds I formed in church meant that when things got bad, there was something else to do besides the next bad thing.”
Tyler J. Vanderwheele is the Professor of Epidemiology at the Harvard School of Public Health and Director of the Human Flourishing Program at Harvard University. He wrote a landmark paper last October which began by documenting the declining American participation in church membership and attendance.
In 2019, Gallup reported that only 36% of American view organized religion “with a great deal of confidence”, down from 68% in 1975. Barna Group found that in 2011, 43% of Americans said they went to church every week, compared to 29% in 2020.
The most common experience of Christians who don’t go to Church seems to be less a deliberate choice and more a substitution of habits. Put differently, a large share of Christians are opting to go it alone, moving their faith into quarters so private that even the church is not allowed in.
So, what does this have to do with the practice of medicine?
Vanderweele makes a startling assertion about halfway through his paper. And then backs it up with data.
“Americans’ growing disaffection with organized religion isn’t just bad news for churches; it also represents a public health crisis, one that has been largely ignored.”
Vanderweele presents data from the Nurses’ Health Study, a prospective study of more than 70,000 participants. Those who attended religious services frequently were 29% less likely to become depressed, 50% less likely to divorce, and five times less likely to commit suicide. Most striking, those attending services weekly were 33% less likely to die during the 16 year follow up period compared to people who did not attend.
Obviously, people do not choose to attend church to add years to their lives. And it’s hard to find large data sets on life in heaven. The health benefits seem to come along for the ride. C.S. Lewis observed, “Aim at Heaven and you will get earth `thrown in`; aim at earth and you will get neither.”
Vanderweele then points to studies that found regular involvement in church activities help to shield children from the “big three” dangers of adolescence: depression, substance abuse, and premature sexual activity. People who attended church as children are also more likely to grow up happy, to be forgiving, to have a sense of mission and purpose, and to volunteer.
Finally, Vanderweele found that those attending regular church activities had far fewer “deaths of despair” - deaths by suicide, drug overdose, or alcohol - than people who never attended services, reducing those deaths by 68% for women and 33% for men in the study.
The numbers are indisputable. I know of no other drug, vaccine, or social program that could lay claim to these results. The question is why? Vanderweele attempts to explain the findings.
Only about a quarter of the effect of service attendance on life expectancy seems to come directly from greater social support. Some of the effects appears to depend on the way religious observance decreased depression and increased optimism, provided hope and a sense of purpose. It also moderated life habits such as smoking and alcohol use,
The positive outcomes for marriage probably depend on the many programs within religious communities that support families and marriages. Another important pathway from religious worship to health and well-being may run through forgiveness. Studies have linked forgiveness to less depression and greater hope, by promoting greater control over one’s emotions and offering an alternative to either suppressing one’s anger or endlessly ruminating over it.
In sum, there are several ways in which religious service attendance might positively influence a person’s mental and physical well-being, including providing a network of social support, offering clear moral guidance, and creating relationships of accountability to reinforce positive behavior.
Nonetheless, what is clear is that religion has important public health implications. The William Glass story illustrates the data that religious communities provide a strong social safety net that other institutions can’t easily replace. This has important implications, not only for religious communities themselves, but also for counseling and health care, for public policy, and for individuals and families.
Consider these implications:
Providers require patients to complete endless surveys of ethnicity, social determinates of health, mental health, alcohol, smoking and drug use, fall risk, etc. Do we owe it to our religious patients to ask about service attendance?
This does not imply that physicians should universally “prescribe” religious service attendance, but a few brief spiritual history questions would guide professionals. For Christians, hearing a doctor ask whether they’ve been attending services might encourage them in a way their pastor or family member cannot.
Beyond the personal level, our public policies should also make sure that the institutions that provided such benefits can go on doing so. It is not simply a matter of civil liberties, but one of public health concern. It should figure more prominently in public-policy discussions, including faith-based nonprofits funding.
Many churches house and support a myriad of recovering organizations made of our most vulnerable. They provide community for the elderly who suffer when isolated from human interaction. Cancelling this access comes with a cost.
Vanderweele’s research indicated that declines in religious service attendance accounted for about 40% of the rise in suicide rates over the past 15 years. Something about the communal religious experience seems to matter. Something powerful takes place here, something unique, something that enhances health and well-being. It is something very different than what comes from solitary or virtual spirituality.
These are my conclusions:
In my most recent Christmas letter, I spoke of the concept of the Church coming to Evergreen Family Medicine through the lives and influence of all those who work here. Taking our values of spirituality to the marketplace. This completes that circle, when we judiciously refer patients back to a place of belonging and support. It is the merging of the house of medicine and a place of worship, each providing its part to enhance total health. It’s all church.
And the time I spend working with the youth at my church; teaching, playing games together, mentoring, listening, going to their ball games, having them over to the house - is as important as what I do at the clinic. It’s all medicine.
Tim Powell MD